Abstract
BackgroundDyspnea is a common trigger of emergency department visits among terminally ill and cancer patients. Frequent emergency department (ED) visits at the end of life are an indicator of poor-quality care. We examined emergency department visit rates due to dyspnea symptoms among palliative patients under enhanced home palliative care.MethodsOur home palliative care team is responsible for patient management by palliative care specialists, residents, home care nurses, social workers, and chaplains. We enhanced home palliative care visits from 5 days a week to 7 days a week, corresponding to one to two extra visits per week based on patient needs, to develop team-based medical services and formulate standard operating procedures for dyspnea care.ResultsOur team cared for a total of 762 patients who exhibited 512 ED visits, 178 of which were due to dyspnea (mean ± SD age, 70.4 ± 13.0 years; 49.4% male). Dyspnea (27.8%) was the most common reason recorded for ED visits, followed by pain (19.0%), GI symptoms (15.7%), and fever (15.3%). The analysis of Group A versus Group B revealed that the proportion of nonfamily workers (42.9% vs. 19.4%) and family members (57.1% vs. 80.6%) acting as caregivers differed significantly (P < 0.05). Compared to the ED visits of the Group A, the risk was decreased by 30.7% in the Group B (P < 0.05).ConclusionsThis study proves that enhanced home palliative care with two additional days per week and formulated standard operating procedures for dyspnea could significantly reduce the rate of ED visits due to non-organic dyspnea during the last 6 months of life.
Highlights
Dyspnea is a common trigger of emergency department visits among terminally ill and cancer patients
During the study period from January 1, 2016 to December 31, 2017, our home palliative care team served a total of 762 patients with cancer: 374 were in Group A, and 388 were in Group B
Analysis of home palliative care revealed that the proportion of nonfamily workers (42.9% vs. 19.4%) and family members (57.1% vs. 80.6%) acting as caregivers was significantly different between Group A and B
Summary
Dyspnea is a common trigger of emergency department visits among terminally ill and cancer patients. We examined emergency department visit rates due to dyspnea symptoms among palliative patients under enhanced home palliative care. Home is the most common place of death for advanced cancer patients and an important site of palliative care in Taiwan and elsewhere [1]. The aim of palliative home care service is to improve the quality of life of patients with cancer and families without raising the total costs of care [2, 3]. About fourfifths of palliative care patients with advanced cancer have repeated visits to the emergency department during the final 6 months of life [7]. Because their clinical judgment abilities are not sufficient, patients tend to have more than one ED visit for the same condition [9]
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